Wounds Of The Heart

We present here because it will be so easy for you to access the internet service. As in this new era, much technology is sophistically offered by connecting to the internet. No any problems to face, just for this day, you can really keep in mind that the book is the best book for you. We offer the best here to read. After deciding how your feeling will be, you can enjoy to visit the link and get the book.

the accident.The size of the shot is not mentioned, but it may be presumed that they were small.-Ed.

Translation.
Wounds of the Heart.In wounds penetrating the cavity of the chest, the heart may be injured, and its lsesion is generally mortal; it is not, however, necessarily fatal if the foreign bo dy has not penetrated into its cavities, as we may be con vinced by reading the Treatise of Senac upon the structure and diseases of the heart, 2 volumes in 4to.A posthumous case of Wolff seems to prove, that there had been a cure in a man who had formerly received a wound in the heart.If we may credit the reports contained in the Melanges des cuneux de la nature, cicatrices have been seen upon the hearts of domes tic animals; and some observers declare that they have even met with them in man.M. Richerand, Nosogr.chirurg.tom.iv, relates that in dissecting the body of an individual who had once received the thrust of a sword above the left hypochon drium, he found the pericardium adhering to the heart by a cicatrix, which was itself attached to the parieties of the left ventricle.
Whenever an instrument wounds the base of the heart, death inevitably follows; for it is from this part that the great bloodvessels issue.In every case of this kind, some one of them must be injured,,and with the blood that issues, life it self escapes: we may add that it is at the base of this organ, that the great cardiac plexus of nerVes is spread out.
Numerous observations prove that men have lived for ma ny days after receiving very deep wounds of the heart; some penetrating into one of the ventricles, others piercing both ventricles, and traversing the whole organ.Saviard cites the case of a man who had his heart pierced through and through, and who still lived from four to five days.On open ing the body after death, Saviard found, that both the left ventricle and the septum which separates it from the right, had been perforated; and that some coagula of blood had stopped up the wound.A young man, according to Thomas Bartho lin, was wounded between the third and fourth ribs of the left side; he was able to return to his house, at a considera ble distance from the place where he was stabbed, and sur vived, for five days, a narrow wound of the right ventricle.
In 1735, Morand exhibited to the Academy of Sciences, the heart of a soldier, who died at the Hospital of Charity, of a sword wound in the anterior and lateral part of the left side of the chest.For three days he did not experience any vio lent symptoms: a fever supervened on the fourth, with diffi culty of respiration, and he died on the ninth.The sword had passed through the pericardium, the inferior part of the right ventricle, the diaphragm, and the liver.We read in the Nouvelle Doctrine Chirurgicale, of M. Leveille, the history of a young man, the left ventricle of whose heart, pierced verti cally, received a wound three or four lines in length: he ex pired the seventh day.Dehors, Rhodius, and Fantoni, have seen individuals, wounded in the heart, survive fourteen, six teen, seventeen, and even twenty days.To explain this phe nomenon, some have conjectured that in the cases just cited, the wounds were so small that the blood only escaped gutta* tim, and that there formed in them a clot, the detachment of which at the end of one or many days, was followed by death.Others have supposed that the wounds were superficial, and that there remained a layer of fibres sufficiently strong to re sist fora time, the escape of the blood; but that they were at length ruptured by the contraction of the heart, and the hsemorrhage which ensued, occasioned immediate death.Saucarette relates, in the Melanges de Chirurgie, a case reported by Levoyer, in which it was established, that the tricuspid valves, had given birth to a fatty body, which, by its interpo sition between the lips of a wound of the right ventricle, pre vented the haemorrhage, in a soldier, who lived for two days after the accident.
Ambrose Pare has recorded, that a gentleman, at Turin, when engaged in single combat, received a thrust of a sword under the left breast, upon which he discontinued the contest, but walked two hundred steps and then expired.The heart presented a wound, which would receive the end of the fin ger, and a great deal ©f blood was extravasated upon the diaphragm.The two ventricles were found pierced through and through in a student of Ingolstadt, who, says Schenk, having received the puncture of a stylet, in the left side of the chest, walked a considerable distance, preserved his presence of mind during an hour, recommended himself to God, con versed and then died.Is it not probable in this case, that the instant the wound was inflicted, the heart contracted spas modically, and thus closed the wound, and prevented the immediate escape of the blood?The hasmorrhage would take place, when the spasm having ceased, the wound would be come extended to its proper dimensions.
M. Sue (Recueilperiodique de la Societe de Medicine de Paris, viijp.31) reports the history of a woman, who pierced the heart of her husband, when asleep, with a very long and sharp golden pin, which she had made expressly for the pur pose.The right ventricle was penetrated completely through.She acknowledged her attrocious crime and was condemned to death.
The diagnostic of wounds of the heart is very difficult.In fact, their situations, a knowledge of the depth to which the instrument penetrated the chest, the abundant flow of blood, the trembling of the whole body, the faintness, the smallness and inequality of the pulse, the cold sweats, the anxiety, the coldness of the limbs, the difficulty of respira tion, sometimes palpitations, and fever if life be prolong ed, are symptoms common to wounds of the great vessels, of the pericardium, and of the diaphragm.When many days elapse between the infliction of the wound and the death of the patient, it is difficult to predict the state in which the heart will be found.
A wound of one of the coronary arteries may be mistaken fora wound of the heart.In the month of August 1697, Lamotte saw the captain of a regiment, Lamar, who receiv ed, behind, a thrust of a sword, between the fifth and sixth left ribs, the point of the instrument made its exit, a little above the nipple of the same side.The captain, cold and without pulse, expired two hours afterwards.They found the pericardium opened in two places; and an oblique wound.not penetrating the heart, extended through the coronary ar tery: The cavity of the thorax was full of blood.
When wounds of the heart have a certain extent, they produce immediate death; if they are narrow, the life of the patient may be prolonged for some days.
What treatment can be opposed to such a wound?If it should not be speedily mortal, we ought to diminish the quan tity of blood by copious venesection, administer antispasmo dics, and keep the patient in the most perfect repose.We should be careful, not to probe or sound the wound, for fear of detaching the clot, and thus removing the only obstacle which opposes some resistance to the flow of the blood.